Assessment of Rural-Urban Differences in Health Care Use and Survival Among Medicare Beneficiaries With Alzheimer Disease and Related Dementia.
Assessment of Rural-Urban Differences in Health Care Use and Survival Among Medicare Beneficiaries With Alzheimer Disease and Related Dementia.
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DOI：
10.1001/jamanetworkopen.2020.22111
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发表时间：
2020-10-01
影响因子：
13.8
通讯作者：
Jutkowitz E
中科院分区：
文献类型：
--
作者：
Rahman M;White EM;Thomas KS;Jutkowitz E
这项队列研究使用了来自美国所有县的疗养院和家庭健康评估的联邦医疗保险声称数据，以调查农村和城市阿尔茨海默病患者和相关痴呆症患者之间的医疗保健利用和存活率的比较。在患有阿尔茨海默病和相关痴呆症(ADRD)的老年美国人中，农村县和城市县的医疗保健使用情况和存活率有何不同？这项队列研究对555名 333名2010年被诊断为ADRD的医疗保险受益人进行了研究，发现在确诊后的6年里，农村县居民的存活率和住院天数都低于城市县居民。与城市县城居民相比，农村居民在养老院的天数更多，在社区的天数更少，在家庭健康和临终关怀方面的时间相似。研究结果表明，诊断后，患有ADRD的农村医疗保险受益人在养老院花费的时间更多，在社区的时间更少，生存时间比城市同行更短。对于美国农村和城市地区患有阿尔茨海默病和相关痴呆症(ADRD)的老年人的存活率和医疗保健使用情况的差异，人们缺乏了解。描述患有ADRD的城乡医疗保险受益人在确诊后6年内的生存和医院、临终关怀、疗养院和家庭保健利用的轨迹。这项回溯性队列研究将2009年1月1日至2016年12月31日的联邦医疗保险索赔数据与美国各县的疗养院和家庭健康评估数据联系起来。2010年新诊断为ADRD的555名 333名医疗保险按服务收费受益人被纳入研究范围。424561人(76.5%)居住在大都市县，75001人(13.5%)居住在小城市县，55771人(10.0%)居住在农村县。受益人居住的县的乡村地区。首次诊断为ADRD后存活的天数；每月在医院、临终关怀疗养院、有家庭保健服务的社区和没有家庭保健服务的社区存活的天数百分比。共有555 333名医疗保险受益人(平均年龄82.0[7.5]岁；345 294名妇女[62.2%]；480 286名白人[86.5%])接受了评估。与大城市县居民相比，农村受益人更年轻(平均[SD]年龄，81.6[7.6]岁比82.1[7.5]岁)，不太可能是女性(34100[61.1%]比264 688[62.3%])，更有可能是白人(50886[91.2%]比361205[85.1%])和符合医疗补助条件的(14264[25.6%]比71656[16.9%])，以及更少的既往慢性病(平均[SD])，6.9[2.8]比7.4[2.9])。居住在大城市县的医疗保险受益人在确诊后平均存活(SD)1183.5(826.0)天。根据个人人口和临床特征进行调整后，农村和小城镇居民的生存时间比城市居民少约1.5个月。农村居民与城市居民相比，在养老院度过的调整后存活天数比例高5.7(95%可信区间，4.0-7.5)个百分点。调整后的住院天数比例农村居民比城市居民低0.7(95%CI，-0.9至-0.4)个百分点，而社区没有家庭医疗护理的天数比例低4.6(95%CI，-6.1至-3.1)个百分点。在家庭健康或临终关怀使用方面没有统计上的显著差异。小城市居民与城市居民的模式与农村居民与城市居民的模式相似，尽管差异的幅度较小。随着确诊时间的延长，农村和城市受益者在社区和疗养院花费的时间差异变得更加明显。研究结果表明，在确诊后，患有ADRD的农村医疗保险受益人在养老院花费的时间更多，在社区的时间更少，接受的家庭保健更少，生存时间比城市同行更短。
This cohort study uses Medicare claims data from nursing home and home health assessments from all US counties to investigate how health care use and survival compares between individuals with Alzheimer disease and related dementia in rural vs urban settings. How do health care use and survival differ between older Americans with Alzheimer disease and related dementia (ADRD) in rural vs urban counties? This cohort study of 555 333 Medicare beneficiaries with ADRD diagnosed in 2010 found that rural county residents experienced lower survival and fewer hospital inpatient days than urban county residents in the 6 years after diagnosis. Compared with urban county residents, rural residents spent more days in nursing homes, fewer days in the community, and a similar amount of time in home health and hospice. Study findings suggest that after diagnosis, rural Medicare beneficiaries with ADRD spend more time in nursing homes, less time in the community, and have shorter survival time than their urban counterparts. There is poor understanding as to how survival and health care use varies among older adults living with Alzheimer disease and related dementia (ADRD) in rural vs urban areas of the United States. To describe survival and trajectories of hospital, hospice, nursing home, and home health care use among rural and urban Medicare beneficiaries with ADRD in the 6 years after diagnosis. This retrospective cohort study linked Medicare claims data from January 1, 2009, to December 31, 2016, with nursing home and home health assessment data from all US counties. A total of 555 333 Medicare fee-for-service beneficiaries newly diagnosed with ADRD in 2010 were included. A total of 424 561 individuals (76.5%) resided in metropolitan counties, 75 001 (13.5%) in micropolitan counties, and 55 771 (10.0%) in rural counties. Rurality of beneficiary’s county of residence. Number of days survived after initial ADRD diagnosis; percent of survived days per month spent in the hospital, hospice nursing home, community with home health care services, and community without home health care services. A total of 555 333 Medicare beneficiaries (mean [SD] age, 82.0 [7.5] years; 345 294 women [62.2%]; 480 286 White [86.5%]) were evaluated. Compared with metropolitan county residents, rural beneficiaries were younger (mean [SD] age, 81.6 [7.6] vs 82.1 [7.5] years), were less likely to be women (34 100 [61.1%] vs 264 688 [62.3%]), were more likely to be White (50 886 [91.2%] vs 361 205 [85.1%]) and Medicaid-eligible (14 264 [25.6%] vs 71 656 [16.9%]), and had fewer preexisting chronic conditions (mean [SD], 6.9 [2.8] vs 7.4 [2.9]). Medicare beneficiaries residing in metropolitan counties survived a mean (SD) of 1183.5 (826.0) days after diagnosis. Adjusting for individual demographic and clinical characteristics, rural and micropolitan county residents survived approximately 1.5 months less than metropolitan residents. The adjusted share of survived days spent in nursing homes was 5.7 (95% CI, 4.0-7.5) percentage points higher for rural vs metropolitan residents. The adjusted share of days in hospitals was 0.7 (95% CI, –0.9 to –0.4) percentage points lower, and the share of days in community without home health care was 4.6 (95% CI, –6.1 to –3.1) percentage points lower for rural vs metropolitan county residents. There were no statistically significant differences in home health or hospice use. Similar patterns were found for micropolitan vs metropolitan residents as for rural vs metropolitan residents, although the magnitude of the differences were smaller. Differences in time spent in community and nursing homes between rural vs metropolitan beneficiaries became more pronounced with further time from diagnosis. Study results suggest that, after diagnosis, rural Medicare beneficiaries with ADRD spend more time in nursing homes and less time in the community, receive less home health care, and have shorter survival than their urban counterparts.
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DOI：
10.1016/j.jalz.2011.03.005
发表时间：
2011-05
期刊：
Alzheimer's & dementia : the journal of the Alzheimer's Association
影响因子：
--
作者：
McKhann GM;Knopman DS;Chertkow H;Hyman BT;Jack CR Jr;Kawas CH;Klunk WE;Koroshetz WJ;Manly JJ;Mayeux R;Mohs RC;Morris JC;Rossor MN;Scheltens P;Carrillo MC;Thies B;Weintraub S;Phelps CH
通讯作者：
Phelps CH
影响因子：
9.9
作者：
James, Bryan D.;Leurgans, Sue E.;Bennett, David A.
通讯作者：
Bennett, David A.
影响因子：
3.4
作者：
Butler, Danielle C.;Petterson, Stephen;Bazemore, Andrew W.
通讯作者：
Bazemore, Andrew W.
DOI：
10.1377/hlthaff.2017.1158
发表时间：
2018-06
期刊：
Health affairs (Project Hope)
影响因子：
--
作者：
Barnes H;Richards MR;McHugh MD;Martsolf G
通讯作者：
Martsolf G
影响因子：
3.5
作者：
Cornell, Portia Y.;Grabowski, David C.;Rahman, Momotazur
通讯作者：
Rahman, Momotazur